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Wednesday, January 25, 2023 - 10:05

DME CMN FORMS DISCONTINUED AS OF 1/1/2023

All Certificates of Medical Necessity (CMNs) and Durable Medical Equipment (DME) Information Forms (DIFs) have been discontinued by CMS effective for dates of service January 1, 2023 and after.

If CMNs or DIFs, including those for oxygen, are included on electronic claims and the from date of service is on or after January 1, 2023, the claims will be rejected by CEDI. Claims with dates of service prior to January 1, 2023 should still include CMN and DIF information in accordance with DME MAC processing and policy guidelines.

Thursday, April 15, 2021 - 11:30

TriWest VA CCN and PC3 Changes

TriWest has selected PGBA as its new Veterans Affairs (VA) Community Care Network (CCN) and Patient-Centered Community Care (PC3) claims processor.

 

 Claims received and accepted by June 8, 2021, will be processed by WPS. For claims received by this date, WPS is committed to processing 98% of CCN Region 4 and PC3 claims by June 30. Any remaining claims will be transferred to PGBA, the new claims processor.
  • Claim submission instructions for the new contractor will vary for a period based on region. Providers are advised to check the authorization letter or VA’s HealthShare Referral Manager (HSRM) for the specific episode of care and should submit claims as instructed.
  • There are no changes to dental or pharmacy services provided through Delta Dental or Express Scripts.
The transition timeline includes these dates:
  • Effective April 1, 2021: Please send CCN Region 5 claims for Kodiak, Alaska, to the new processor, PGBA.
  • Effective April 1, 2021: Providers in Regions 4 and 5 are encouraged to begin the registration process for Electronic Funds Transfer (EFT) and/or Electronic Remittance Advice (ERA) with PGBA. WPS is no longer accepting new enrollments for these transactions.
  • Effective June 9, 2021: All electronic transactions and paper claims for Region 4 CCN and PC3 must be sent to PGBA. 
  • Effective June 15, 2021: PGBA will receive and process all remaining CCN Region 5 EDI transactions. 
 
Claims mailing address:
 PGBA’s mailing address for CCN claims is:
TriWest VA CCN Claims
PO Box 108851
Florence, SC 29502-8851

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